BACKGROUND
Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach recommended physical activity levels and have overweight. This has health implications both physical and psychological, including increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology to improve health outcomes in cancer survivors with overweight/obesity.
OBJECTIVE
This study sought to investigate whether a personalized mHealth behavior change intervention improved physical and psychological health outcomes in cancer survivors with overweight/obesity.
METHODS
A sample of 123 cancer survivors (body mass index ≥25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle information and education session with physiotherapists, a dietician, and clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal-setting to incrementally increase physical activity (with feedback and review of goals through short message service text messaging contact with the research team). Objective measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up).
RESULTS
Rates of attrition were 21% for the control condition and 14% for the intervention condition. Using intent-to-treat analysis significant reductions in body mass index (BMI) (F(2,242) = 4.149, p = .017, ηp2= .033) and waist circumference (F(2,242) = 3.342, p = .037, np2 = .027) were seen in the intervention group. Over the 24-week study BMI was reduced by 0.52 in the intervention condition, relative to a non-significant reduction of 0.11 in the control arm. Waist circumference reduced by 3.02cm in the intervention relative to 1.82cm in the control condition. High levels of attainment for step count goals were observed with significantly higher levels of physical activity recorded for participants in the intervention group post-intervention (t(105) =2.60, p=.011) and at follow-up (t(105) =2.43, p=.017), accounting for up to 1999 additional steps per day.
CONCLUSIONS
The results demonstrate that for cancer survivors with a BMI ≥ 25 lifestyle education and personalized goal-setting using mobile technology can yield significant change on clinically relevant health indicators. Further research is needed to elucidate to mechanisms for behavior change and explore the capacity for mHealth interventions to improve broader health and wellbeing outcomes in the growing population of cancer survivors.
CLINICALTRIAL
ISRCTN-18676721 https://doi.org/10.1186/ISRCTN18676721
INTERNATIONAL REGISTERED REPORT
RR2-10.2196/13214
Goal setting for health behavior change: evidence from an obesity intervention for rural low-income women
